What women want: Exploring pregnant women’s preferences for alternative models of maternity care

Fawsitt, Christopher G.; Bourke, Jane; Lutomski, Jennifer E.; Meaney, Sarah; McElroy, Brendan; Murphy, Raegan; Greene, Richard A.

doi:10.1016/j.healthpol.2016.10.010

Cited by 25 publications

(29 citation statements)

References 28 publications

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“…Interestingly, the respondents' independent decision on money spending and seeking health were not found to have any relationship with WTP for pregnancy in this study. This is in contrast to what Fawsitt and colleagues found out that if women were involved in decision-making actively during labour, it increased their willingness to pay more in order to have improvement of maternity services [15]. Mohale and colleagues documented the relationship between women's literacy and improved utilization of maternity care [16].…”

Section: Discussionmentioning

confidence: 87%

Factors Affecting Women-Willingness to Pay for Maternal, Neonatal andChild Health Services (MNCH) in Gombe State, Nigeria

Yahya¹,

Pumpaibool²

2017

J Women's Health Care

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Background: Gombe State in North Eastern Nigeria is one of the states in the region that records the highest maternal and new-born death rates in the world. The region has a maternal mortality ratio of 1549/100,000, child mortality rate of 260/1,000 and neonatal mortality rate of 43/1,000. With a poverty incidence of 72.2% in the state and the displacement due to insurgency, a great deal of women in the villages is vulnerable to more poverty and maternal deaths. Establishing the factors that affect the willingness to pay (WTP) for maternal services will help to improve maternal health services thereby reducing maternal deaths in the state. This study looked at the factors that affect women's willingness to pay for maternal services in relation to antenatal care (ANC), delivery in health facilities and post-natal care (PNC) through a baseline survey.Methods: This study was cross sectional where data were collected from women groups (including women not registered with the groups) in two purposively selected Local Government Areas (LGAs) of the state. Seven hundred and fifty (750) women were sampled for the survey in the two LGAs. The main outcome variables are utilization of maternal service (specifically improved antenatal care attendance, facility delivery and postnatal care) and WTP for these services by the women. Descriptive statistics of the respondents were analysed using IBM SPSS 22 software. Logistic regression analysis was done to determine the factors affecting WTP for the maternal services. Results:The findings from this study have shown statistically significant association between WTP for maternal health care and several factors. Women are more likely to be willingness to pay for ANC and delivery in the health facility if they belong to the savings and loans group (p<0.05), had an average of 1-10 visits to a facility, married (p<0.05), can read and write in English (p<0.05) and live near health facilities (p<0.05). Income and employment (p<0.05) are additional factors affecting WTP for delivery. Post-natal care on the other hand was only associated with membership of savings and loans group. Conclusions:Factors associated with the willingness to pay ANC and delivery in health facilities according to the findings of this study were membership of savings and loans group, closeness to a health facility, education, income and marital status. Number of previous visits to the health facility and occupation were also found to be significant predictors of willingness to pay for maternal services. Further studies on the association of WTP and PNC are suggested in order to improve PNC in the state.

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Section: Discussionmentioning

confidence: 87%

Factors Affecting Women-Willingness to Pay for Maternal, Neonatal andChild Health Services (MNCH) in Gombe State, Nigeria

Yahya¹,

Pumpaibool²

2017

J Women's Health Care

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“…In Ireland, choice is important to women when it comes to maternity care [ 4 , 14 ]. In particular, they prioritise safety for their baby and the continuity of care over a hospital’s facilities.…”

Section: Discussionmentioning

confidence: 99%

“…In particular, they prioritise safety for their baby and the continuity of care over a hospital’s facilities. A qualitative paper found that women who choose private care felt an added sense of security in labour due to the continuity of care with their obstetrician [ 4 ]. The abolition of the private and semi-private packages of care in public hospitals would deny women who have been paying PHI, perhaps for many years, of choice.…”

Section: Discussionmentioning

confidence: 99%

“…Despite government funding of the health services, a large proportion of the adult population in the Republic of Ireland takes out PHI [ 3 ]. The reasons for this vary depending on the individual, but privately, there is usually quicker access to services, particularly elective services, a wider choice of individual specialists with better continuity of care and access to better facilities in both public and private hospitals [ 3 , 4 ].…”

Section: Introductionmentioning

confidence: 99%

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Trends in private maternity care in Ireland’s capital during and after the Great Economic Recession 2009–2017

et al. 2020

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Background Maternity care in hospitals in the Republic of Ireland is funded by a hybrid of public finance and private health insurance. Aims The aim of this longitudinal observational study was to investigate the annual trends in maternity care from 2009 to 2017 during and after the Great Economic Recession. Methods All women who delivered a singleton baby weighing ≥ 500 g during the 9 years (2009–2017) were included. Detailed clinical and sociodemographic details were computerised at the first antenatal visit by a trained midwife. Women who delivered their first baby during the study were analysed longitudinally if they delivered again during the 9 years. Results The mean age of the 73,266 women was 31.3 ± 5.6 years, 40.1% were nulliparas, and 70.3% were Irish-born. Overall, 75.2% opted for the public, 10.8% for the semi-private, and 14.0% for the private package of maternity care. Over the 9 years, the number of women choosing private and semi-private care decreased by 21.6% and 35.3%, respectively, whereas the number of women using public care increased by 12.3%. Most women opted for the same package of care in subsequent pregnancies. Conclusions Ireland’s recent economic recession was accompanied by an overall decrease in the number of women choosing private maternity care after 2009. Furthermore, economic recovery with increasing female employment after 2012 was not associated with a recovery in demand for private care. These findings have important implications for healthcare policies and for the future organisation and funding of our maternity services.

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“…The attributes included continuity of care, average waiting time at each antenatal visit, and access to obstetric, anaesthetic and neonatal care. These attributes derived from qualitative research, which is described elsewhere [ 22 ]. The attributes described the ‘typical’ scenario found in a CLU and MLU.…”

Section: Methodsmentioning

confidence: 99%

A Cost-Benefit Analysis of Two Alternative Models of Maternity Care in Ireland

Fawsitt

Bourke

Murphy

et al. 2017

Appl Health Econ Health Policy

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BackgroundThe Irish government has committed to expand midwifery-led care alongside consultant-led care nationally, although very little is known about the potential net benefits of this reconfiguration.ObjectivesTo formally compare the costs and benefits of the major models of care in Ireland, with a view to informing priority setting using the contingent valuation technique and cost-benefit analysis.MethodsA marginal payment scale willingness-to-pay question was adopted from an ex ante perspective. 450 pregnant women were invited to participate in the study. Cost estimates were collected primarily, describing the average cost of a package of care. Net benefit estimates were calculated over a 1-year cycle using a third-party payer perspective.ResultsTo avoid midwifery-led care, women were willing to pay €821.13 (95% CI 761.66–1150.41); to avoid consultant-led care, women were willing to pay €795.06 (95% CI 695.51–921.15). The average cost of a package of consultant- and midwifery-led care was €1,762.12 (95% CI 1496.73–2027.51) and €1018.47 (95% CI 916.61–1120.33), respectively. Midwifery-led care ranked as the best use of resources, generating a net benefit of €1491.22 (95% CI 989.35–1991.93), compared with €123.23 (95% CI −376.58 to 621.42) for consultant-led care.ConclusionsWhile both models of care are cost-beneficial, the decision to provide both alternatives may be constrained by resource issues. If only one alternative can be implemented then midwifery-led care should be undertaken for low-risk women, leaving consultant-led care for high-risk women. However, pursuing one alternative contradicts a key objective of government policy, which seeks to improve maternal choice. Ideally, multiple alternatives should be pursued.Electronic supplementary materialThe online version of this article (doi:10.1007/s40258-017-0344-8) contains supplementary material, which is available to authorized users.

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What women want: Exploring pregnant women’s preferences for alternative models of maternity care

Cited by 25 publications

References 28 publications

Factors Affecting Women-Willingness to Pay for Maternal, Neonatal andChild Health Services (MNCH) in Gombe State, Nigeria

Factors Affecting Women-Willingness to Pay for Maternal, Neonatal andChild Health Services (MNCH) in Gombe State, Nigeria

Trends in private maternity care in Ireland’s capital during and after the Great Economic Recession 2009–2017

A Cost-Benefit Analysis of Two Alternative Models of Maternity Care in Ireland

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